NUR 378 Exam 3 Pharmacology (Concordia
St. Paul) 2026 | Verified Questions &
Answers | Comprehensive Study Guide,
Practice Exam & Pharmacology Review
NUR 378 PHARMACOLOGY EXAM 3 Concordia St. Paul | 2026
====================================================================
============
DOCUMENT OVERVIEW:
• This comprehensive practice exam contains verified pharmacology questions
designed to test your knowledge across all major drug classifications, mechanisms
of action, nursing considerations, and clinical applications essential for safe
medication administration and patient care.
• Study this material by reviewing each question carefully, attempting to answer
before checking the correct response, and using the detailed rationales to
understand not just what is correct, but why distractors are incorrect—this
reinforces deep learning and retention for clinical practice.
====================================================================
============
QUESTION 1: A patient is prescribed metformin for type 2 diabetes. Which
statement best describes the primary mechanism of action of this
medication?
A) Stimulates insulin release from the pancreatic beta cells
B) Increases insulin sensitivity and decreases hepatic glucose production
C) Slows carbohydrate digestion in the small intestine
D) Increases urinary glucose excretion through the kidneys
E) Promotes glucagon secretion to raise blood glucose levels
CORRECT ANSWER: B) Increases insulin sensitivity and decreases hepatic
glucose production
,RATIONALE: Metformin is a biguanide that works primarily by decreasing hepatic
glucose production (gluconeogenesis) and improving insulin sensitivity in muscle
and adipose tissue. It does NOT stimulate insulin release (that is sulfonylureas),
does NOT slow carbohydrate digestion (that is alpha-glucosidase inhibitors), does
NOT increase urinary glucose excretion (that is SGLT2 inhibitors), and does NOT
promote glucagon (that would worsen hyperglycemia). Metformin is considered
first-line therapy for type 2 diabetes due to its cardiovascular benefits and low
hypoglycemia risk when used alone.
====================================================================
============
QUESTION 2: A 65-year-old patient with hypertension is started on lisinopril.
Which adverse effect should the nurse counsel the patient to anticipate and
report immediately?
A) Hypoglycemia and tremors
B) A persistent dry cough and hyperkalemia
C) Tachycardia and palpitations
D) Photosensitivity and skin rash
E) Constipation and urinary retention
CORRECT ANSWER: B) A persistent dry cough and hyperkalemia
RATIONALE: Lisinopril is an ACE inhibitor that commonly causes a persistent dry
cough (affecting 10-20% of patients) due to accumulation of bradykinin in the
respiratory tract. Hyperkalemia is also a significant concern with ACE inhibitors
because they reduce aldosterone secretion, leading to potassium retention. The dry
cough often necessitates switching to an ARB (angiotensin II receptor blocker).
Options A, C, D, and E are not typical of ACE inhibitors and would suggest other
drug classes or conditions.
====================================================================
============
,QUESTION 3: A patient receiving intravenous vancomycin reports redness and
flushing of the face and neck. What is the most appropriate nursing
intervention?
A) Discontinue the infusion immediately and call the prescriber
B) Slow the infusion rate and administer an antihistamine as prescribed
C) Increase the infusion rate to complete the dose faster
D) Apply cool compresses to the face and continue the infusion
E) Document the symptom and continue without intervention
CORRECT ANSWER: B) Slow the infusion rate and administer an
antihistamine as prescribed
RATIONALE: Flushing and erythema during vancomycin infusion are classic signs of
"red man syndrome," caused by rapid infusion triggering mast cell degranulation
and histamine release. This is NOT an allergy but a rate-related adverse effect.
Management includes slowing the infusion rate (infuse over at least 60 minutes),
premedication with antihistamines (diphenhydramine) and sometimes
corticosteroids, or corticosteroid pretreatment. The infusion should NOT be
discontinued unless true anaphylaxis occurs, nor should the rate be increased. Red
man syndrome can be prevented with proper infusion rate and premedication.
====================================================================
============
QUESTION 4: A nurse is administering a medication with a narrow therapeutic
index. Which action is MOST critical?
A) Administering the dose as ordered without verification
B) Monitoring serum levels and adjusting doses based on therapeutic drug
monitoring results
C) Giving higher initial doses to achieve faster therapeutic effect
D) Allowing patients to self-adjust their doses based on symptoms
E) Combining multiple drugs to enhance the therapeutic effect
, CORRECT ANSWER: B) Monitoring serum levels and adjusting doses based
on therapeutic drug monitoring results
RATIONALE: Drugs with narrow therapeutic indices (like digoxin, lithium,
phenytoin, aminoglycosides, and vancomycin) have a small margin between
therapeutic and toxic doses. Therapeutic drug monitoring (TDM) with serum level
measurements is essential to maintain safety and efficacy. Options A, C, D, and E all
increase the risk of toxicity. Proper dosing based on serum levels prevents
overdose and underdose, ensuring optimal patient outcomes.
====================================================================
============
QUESTION 5: A patient is prescribed clarithromycin (an antibiotic) and
simvastatin (a statin). The nurse recognizes that this combination presents a
significant drug interaction risk. What is the primary concern?
A) Clarithromycin decreases statin effectiveness
B) Clarithromycin is a CYP3A4 inhibitor, increasing simvastatin levels and risk of
myopathy and rhabdomyolysis
C) The combination causes severe hypertension
D) Simvastatin increases antibiotic toxicity
E) Both drugs are contraindicated in patients with renal disease
CORRECT ANSWER: B) Clarithromycin is a CYP3A4 inhibitor, increasing
simvastatin levels and risk of myopathy and rhabdomyolysis
RATIONALE: Clarithromycin is a potent CYP3A4 inhibitor that blocks the hepatic
metabolism of simvastatin, leading to elevated statin levels and increased risk of
muscle toxicity (myopathy) and the severe complication of rhabdomyolysis. This
interaction is clinically significant and often requires substituting clarithromycin
with a non-interacting antibiotic (like azithromycin) or temporarily discontinuing the
statin. Understanding enzyme inhibition is critical for preventing serious adverse
effects from drug interactions.
St. Paul) 2026 | Verified Questions &
Answers | Comprehensive Study Guide,
Practice Exam & Pharmacology Review
NUR 378 PHARMACOLOGY EXAM 3 Concordia St. Paul | 2026
====================================================================
============
DOCUMENT OVERVIEW:
• This comprehensive practice exam contains verified pharmacology questions
designed to test your knowledge across all major drug classifications, mechanisms
of action, nursing considerations, and clinical applications essential for safe
medication administration and patient care.
• Study this material by reviewing each question carefully, attempting to answer
before checking the correct response, and using the detailed rationales to
understand not just what is correct, but why distractors are incorrect—this
reinforces deep learning and retention for clinical practice.
====================================================================
============
QUESTION 1: A patient is prescribed metformin for type 2 diabetes. Which
statement best describes the primary mechanism of action of this
medication?
A) Stimulates insulin release from the pancreatic beta cells
B) Increases insulin sensitivity and decreases hepatic glucose production
C) Slows carbohydrate digestion in the small intestine
D) Increases urinary glucose excretion through the kidneys
E) Promotes glucagon secretion to raise blood glucose levels
CORRECT ANSWER: B) Increases insulin sensitivity and decreases hepatic
glucose production
,RATIONALE: Metformin is a biguanide that works primarily by decreasing hepatic
glucose production (gluconeogenesis) and improving insulin sensitivity in muscle
and adipose tissue. It does NOT stimulate insulin release (that is sulfonylureas),
does NOT slow carbohydrate digestion (that is alpha-glucosidase inhibitors), does
NOT increase urinary glucose excretion (that is SGLT2 inhibitors), and does NOT
promote glucagon (that would worsen hyperglycemia). Metformin is considered
first-line therapy for type 2 diabetes due to its cardiovascular benefits and low
hypoglycemia risk when used alone.
====================================================================
============
QUESTION 2: A 65-year-old patient with hypertension is started on lisinopril.
Which adverse effect should the nurse counsel the patient to anticipate and
report immediately?
A) Hypoglycemia and tremors
B) A persistent dry cough and hyperkalemia
C) Tachycardia and palpitations
D) Photosensitivity and skin rash
E) Constipation and urinary retention
CORRECT ANSWER: B) A persistent dry cough and hyperkalemia
RATIONALE: Lisinopril is an ACE inhibitor that commonly causes a persistent dry
cough (affecting 10-20% of patients) due to accumulation of bradykinin in the
respiratory tract. Hyperkalemia is also a significant concern with ACE inhibitors
because they reduce aldosterone secretion, leading to potassium retention. The dry
cough often necessitates switching to an ARB (angiotensin II receptor blocker).
Options A, C, D, and E are not typical of ACE inhibitors and would suggest other
drug classes or conditions.
====================================================================
============
,QUESTION 3: A patient receiving intravenous vancomycin reports redness and
flushing of the face and neck. What is the most appropriate nursing
intervention?
A) Discontinue the infusion immediately and call the prescriber
B) Slow the infusion rate and administer an antihistamine as prescribed
C) Increase the infusion rate to complete the dose faster
D) Apply cool compresses to the face and continue the infusion
E) Document the symptom and continue without intervention
CORRECT ANSWER: B) Slow the infusion rate and administer an
antihistamine as prescribed
RATIONALE: Flushing and erythema during vancomycin infusion are classic signs of
"red man syndrome," caused by rapid infusion triggering mast cell degranulation
and histamine release. This is NOT an allergy but a rate-related adverse effect.
Management includes slowing the infusion rate (infuse over at least 60 minutes),
premedication with antihistamines (diphenhydramine) and sometimes
corticosteroids, or corticosteroid pretreatment. The infusion should NOT be
discontinued unless true anaphylaxis occurs, nor should the rate be increased. Red
man syndrome can be prevented with proper infusion rate and premedication.
====================================================================
============
QUESTION 4: A nurse is administering a medication with a narrow therapeutic
index. Which action is MOST critical?
A) Administering the dose as ordered without verification
B) Monitoring serum levels and adjusting doses based on therapeutic drug
monitoring results
C) Giving higher initial doses to achieve faster therapeutic effect
D) Allowing patients to self-adjust their doses based on symptoms
E) Combining multiple drugs to enhance the therapeutic effect
, CORRECT ANSWER: B) Monitoring serum levels and adjusting doses based
on therapeutic drug monitoring results
RATIONALE: Drugs with narrow therapeutic indices (like digoxin, lithium,
phenytoin, aminoglycosides, and vancomycin) have a small margin between
therapeutic and toxic doses. Therapeutic drug monitoring (TDM) with serum level
measurements is essential to maintain safety and efficacy. Options A, C, D, and E all
increase the risk of toxicity. Proper dosing based on serum levels prevents
overdose and underdose, ensuring optimal patient outcomes.
====================================================================
============
QUESTION 5: A patient is prescribed clarithromycin (an antibiotic) and
simvastatin (a statin). The nurse recognizes that this combination presents a
significant drug interaction risk. What is the primary concern?
A) Clarithromycin decreases statin effectiveness
B) Clarithromycin is a CYP3A4 inhibitor, increasing simvastatin levels and risk of
myopathy and rhabdomyolysis
C) The combination causes severe hypertension
D) Simvastatin increases antibiotic toxicity
E) Both drugs are contraindicated in patients with renal disease
CORRECT ANSWER: B) Clarithromycin is a CYP3A4 inhibitor, increasing
simvastatin levels and risk of myopathy and rhabdomyolysis
RATIONALE: Clarithromycin is a potent CYP3A4 inhibitor that blocks the hepatic
metabolism of simvastatin, leading to elevated statin levels and increased risk of
muscle toxicity (myopathy) and the severe complication of rhabdomyolysis. This
interaction is clinically significant and often requires substituting clarithromycin
with a non-interacting antibiotic (like azithromycin) or temporarily discontinuing the
statin. Understanding enzyme inhibition is critical for preventing serious adverse
effects from drug interactions.
